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Dr. Dejan Milasinovic
Doctor at Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
European Heart Journal, Volume 40, Issue 38, 7 October 2019, Pages 3143–3153
To compare the effects of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across different hitherto studied patient groups.
This aggregate-data meta-analysis included 7 randomized controlled trials with the overall population of 8020 (4014 TAVI vs. 4006 SAVR), combining patients at high, intermediate and low surgical risk. The primary outcome was all-cause mortality up to 2 years (and up to the longest available follow-up within each study).
The main finding of this meta-analysis is that TAVI poses a survival benefit compared with SAVR across the whole spectrum of baseline surgical risk in patients with symptomatic severe aortic stenosis (AS). To this end, the authors highlight the consistency of the observed results in terms of low statistical heterogeneity among the included trials for the primary endpoint of all-cause mortality, and no significant interaction between the subgroups of surgical risk. Moreover, the benefit of TAVI was even accentuated when utilizing transfemoral vs. transthoracic route (as shown by the significant interaction between those two TAVI access sites on the all-cause mortality; p=0.032).
With these results, the use of TAVI for a majority of patients with symptomatic severe AS may seem to be warranted, albeit taking into account the future research in terms of transcatheter heart valve (THV) durability and the impact of new technical and technological developments in both the interventional and surgical arena.
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